1. The patient has been in the hospital. The beginning of the disease was gradual:
nausea, vomiting, dark urine, аcholic stools, yellowness of the skin and scleras.
The liver is protruded by 3 cm. Jaundice was intensified on the 14th day of the
disease. The liver diminished in sizes. Due to what complication of viral
hepatitis, has the patient’s condition worsened?
A. Hepatic encephlopathy *
B. Meningitis
C. Relapse of viral hepatitis
D. Cholangitis
E. Infectious-toxic shock
2. A 20 yr old woman with a 3-4 month history of bloody diarrhoea; stool
examination negative for ova and parasites;stool cultures negative for
clostridium,campylobacter and yersinia;normal small bowel
series;oedema,hyperemia and ulceration of the rectum and sigmoid colon seen
on sigmoidoscopic examination.Select the most likely Diagnosis:
A. Ulcerative colitis *
B. Gastroenteritis
C. Carcinoid syndrome
D. Zollinger-Ellison syndrome
E. Granulomatous colitis
3. A 36yr. Old alcoholic patient has cirrhosis and pancreatic insufficiency due to
recurrent pancreatitis. He complaints of nightblindness, decreased ability to taste
food, and dry skin with hyperpigmentation. These complaints suggest deficiency
of:
A. Zinc *
B. Copper
C. Selenium
D. Chromium
E. Manganese
4. A 47 year old man presents to his physician with progressive abdominal
swelling.On examination he is found to have ascites and a tender,enlarged
liver.If the patient describes a chronic course associated with wasting and low
grade fever,the diffrential diagnosis should include everything EXCEPT:
A. Chronic Pancreatitis *
B. Tuberculosis
C. Cirrhosis with hepatocellular carcinoma
D. Hepatitis
E. Alcoholic liver disease with cirrhosis
5. A 45yr. Old man is admitted with his 3rd episode of upper gastrointestinal
haemorrhage. He had 2 prior ulcer operation. Zollinger-Ellison syndrome is
suspected. All the following would support your suspicions EXCEPT:
A. Supression of hypergastrinaemia by secretin given IV *
B. A fasting gastrin level of 450pg/ml.
C. Post operative notes detailling ulcers in the duodenum and jejunum
D. Liver metastasis on CT scan
E. A history of diarrhoea
6. A 60yr. Old woman, mother of 6 children, developed sudden onset of upper
abdominal pain radiating to the back, associated with nausea, vomitting, fever
and chills. Subsequently, she noticed yellow discoloration of her sclera and skin.
On physical examination the patient was found to be febrile with temp.of 38.9C,
along with right upper quadrant tenderness.Most likely Diagnosis:
A. Choledocholithiasis *
B. Benign biliary stricture
C. Malibnant biliary stricture
D. Carcinoma of the head of the pancreas
E. Choledochal cyst
7. The family doctor diagnosed in a patient an acute bleeding of an intestine. What
is professional tactics of the doctor in this situation?
A. The urgent hospitalisation in sergical departmewnt. *
B. To inject intravenously the aminocapronic acid.
C. The urgent hospitalization in therapeutic department.
D. A day time hospital.
E. A hospital at home.
8. An elderly man presents with severe epigastric pain radiating to the right
hypochondrium. The pain has been worsening over the past day and a half and
goes through to his back and shoulders. The patient feels sick and has vomited
several times. He is jaundiced.
Hepatitis A
Hepatitis B
Hepatitis C
* Gallstones
Pancreatitis
9. An elderly woman presents with painless jaundice and weight loss. On physical
examination you find the gallbladder to be enlarged. Choose the single most
likely diagnosis
Gallstones
Crohn's disease
Duodenal ulcer
Duodenitis
* Carcinoma head of pancreas
10. An elderly woman presents with painless jaundice and weight loss. On physical
examination you find the gallbladder to be enlarged. She enjoys smoking and
drinking. Choose the single most likely investigation from the list of options
above
* Carcinoma head of pancreas
Reflux oesophagitis
Acute pancreatitis
Chronic pancreatitis
Duodenal ulcer
11.A patient complains of feeling heaviness behind his breast bone, periodical
sensation of food stoppage, dysphagy. During the X-ray examination barium
contrast revealed a single saccular outpouching of anterodextral esophagus wall
with regular contours and rigidly outlined neck. What is the most probable
diagnosis?
A. Hiatal hernia
B. Esophageal diverticulum *
C. Varix dilatation of esophageal veins
D. Cancer of esophagus
E. Esophageal polyp
12.A patient suffers from chronic recurrent pancreatitis with evident disturbance of
exocrinous function. After intake of rich spicy food and spirits his stool becomes
fatty. Reduced production of what factor is the most probable cause of
steatorrhea?
A. Acidity of gastric juice
B. Tripsin
C. Amylase
D. Lipase *
E. Alkaline phosphatase
13.A 38 y.o. woman was hospitalized to the surgical unit with acute abdominal pain
irradiating to the spine and vomiting. On laparocentesis hemmorhagic fluid is
obtained. What disease is suspected?
A. Acute enterocolitis
B. Acute pancreatitis *
C. Acute appendicitis
D. Renal colic
E. Perforative gastric ulcer
14.A patient is 65 y.o. He has been a smoker for 40 years. Hew has lost 10 kg
during the last 3 months. Complains of pain in the epigastric area after taking
meals, diarrhea, jaundice. Physical examination revealed enlarged, painless
gallbladder. Feces are light-coloured and clay-like. Blood analysis revealed
increased level of whole and direct bilirubin, alkaline phosphotase and
glutaminepyruvate transferase. Clinical urine analysis showed positive bilirubin
reaction and negative urobilinogene reaction. Where is the initial process that
caused these changes?
A. In pancreas *
B. In gallbladder
C. In common bile duct
D. In liver
E. In duodenum
15.A 50 y.o. woman for 1 year complained of attacks of right subcostal pain after
fatty meal. Last week the attacks have repeated every day and become more
painful. What diagnostic study would you recommend?
A. Blood cell count
B. Ultrasound examination of the gallbladder *
C. Liver function tests
D. X-ray examination of the gastrointestinal tract
E. Ultrasound study of the pancreas
16.A 75 y.o. man has acute pain in the paraumbilical region accompanied by
vomiting and feeling of abdominal swelling in approximately 30 minutes after
meals. He lost 10 kg during the last months because he doesn't eat in order to
avoid pain. Abdomen examination reveals no changes in the periods between
pain attacks. Above the right femoral artery a murmur can be auscultated,
peripheral pulsation in the lower extrimities is weak. X-ray examination of
stomach and colonoscopy reealed no changes. What is the leading factor of this
pathogenesis?
A. Inflammation
B. Ischemia *
C. Psychogenic changes
D. Neoplastic process
E. Transient obstruction
17.Medical examination of a man revealed "geographic tongue". This
microsymptom is the evidence of the following vitamin deficiency:
A. Vitamin C
B. Vitamin D
C. Vitamin PP
D. Vitamin A
E. Vitamins of B group *
18.A 45 y.o. man complains of having intensive pain in the epigastric region 1,5-2
hours later after food intake. He has been suffering from ulcer for 11 years.
Objectively: t0- 36,50С, RR- 16/min, Ps- 70 bpm, AP- 120/80 mm Hg. On
palpation: local painfulness in the right epigastric region. What parameters of
intragastric Ph-meter in the region of stomach body are the most typical for this
patient's disease?
A. рН = 5,0-6,0
B. рН = 6,0-7,0
C. рН = 3,0-4,0
D. рН = 4,0-5,0
E. рН = 1,0-2,0 *
19.A man with liver cirrhosis complained of nasal bleedings, right subcostal pain,
weakness, nausea. On physical examination: jaundice, hemorrhagic rash,
enlarged liver span (of 14 cm), liver edge irregular. What is the cause of
hemorrhagic syndrome in this patient?
A. Decreased liver production of procoagulants. *
B. As a consequence of DIC.
C. Thrombocytopenia.
D. As a result of portal hypertension.
E. K and C hypovitaminosis.
20.A 45-year-old man for 1 month has complained of epigastric and right subcostal
aching pain, pruritus, indigestion, dark color of the urine and acholic stool,
fever, and significant weight loss. On exam: jaundice, presence of Curvuasier’s
sign. US scan did not reveal stones in the gallbladder and choledochus. What is
the most likely diagnosis?
A. Cancer of the pancreas head *
B. Gallbladder stones
C. Chronic pancreatitis
D. Chronic cholangitis
E. Chronic hepatitis
21.A 22-year-old woman complained of right subcostal aching pain, nausea, and
decreased appetite. She fell ill 2 months after appendectomy when jaundice
appeared. She was treated in an infectious hospital. 1 year later above mentioned
symptoms developed. On exam: the subicteric sclerae, enlarged firm liver. Your
preliminary diagnosis
A. Chronic viral hepatitis *
B. Calculous cholecystitis
C. Gilbert’s disease
D. Acute viral hepatitis
E. Chronic cholangitis
22.A 50 -year-old woman for 1 year complained of attacks of right subcostal pain
after fatty meal. Last week the attacks have repeated every day and become
more painful. What diagnostic study would you recommend?
A. Ultrasound examination of the gallbladder *
B. Liver function tests
C. X-ray examination of the gastrointestinal tract
D. Ultrasound study of the pancreas
E. Blood cell count
23.A 27 -year-old man complained of aching epigastric pain just after meal,
heartburn, and nausea. Stomach endoscopy revealed a large amount of mucus,
hyperemia and edema of mucous membrane in gastric fundus with areas of
atrophy. Establish the diagnosis.
A. Chronic type A gastritis *
B. Chronic type B gastritis
C. Peptic ulcer of the stomach
D. Chronic type C gastritis
E. Menetrier’s disease
24.A 39 -year-old woman complained of squeezed epigastric pain 1 hour after meal
and heartburn. She had been ill for 2 years. On palpation, there was moderate
tenderness in pyloroduodenal area. Antral gastritis was revealed on gastroscopy.
What study can establish genesis of the disease?
A. Revealing of Helicobacter infection in gastric mucosa *
B. Detection of autoantibodies in the serum
C. Gastrin level in blood
D. Examination of stomach secretion
E. Examination of stomach motor function
25.A patient, aged 48, complains of heaviness in the right hypochondrium, itching
of the skin. Repeatedly he had been treated in infectious diseases hospital due to
icterus and itch. Objectively: meteorism, ascitis, dilation of abdominal wall
veins, protruded navel, spleen enlargement. Diagnosis is:
A. Liver cirrhosis *
B. Cancer of the liver
C. Cancer of the head of pancreas
D. Gallstones
E. Viral hepatitis B
26.A 27-year-old man complains of pains in epigastrium which are relieved by
food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous
presents Hеlicobacter Pylori. Diagnosis is:
A. Gastritis of type B *
B. Gastritis of A type
C. Reflux - gastritis
D. Menetrier's gastritis
E. Rigid antral gastritis
27.In the development of the inflammation processes glucocorticoids reduce the
level of a certain most important active enzyme. It results also in the reducing of
the synthesis of prostaglandins and leukotrienes which has a key-role in the
development of the inflammation processes. Give the exact term of this enzyme.
A. Phospholipase A2 *
B. Arachidonic acid
C. Lipoxygenasе
D. Cyclooxygenase – 1
E. Cyclooxygenase – 2
28.The patient has been in the hospital. The beginning of the disease was gradual:
nausea, vomiting, dark urine, аcholic stools, yellowness of the skin and scleras.
The liver is protruded by 3 cm. Jaundice was intensified on the 14th day of the
disease. The liver diminished in sizes. Due to what complication of viral
hepatitis, has the patient’s condition worsened?
F. Hepatic encephlopathy *
G. Meningitis
H. Relapse of viral hepatitis
I. Cholangitis
J. Infectious-toxic shock
29.A 20 yr old woman with a 3-4 month history of bloody diarrhoea; stool
examination negative for ova and parasites;stool cultures negative for
clostridium,campylobacter and yersinia;normal small bowel
series;oedema,hyperemia and ulceration of the rectum and sigmoid colon seen
on sigmoidoscopic examination.Select the most likely Diagnosis:
F. Ulcerative colitis *
G. Gastroenteritis
H. Carcinoid syndrome
I. Zollinger-Ellison syndrome
J. Granulomatous colitis
30.A 36yr. Old alcoholic patient has cirrhosis and pancreatic insufficiency due to
recurrent pancreatitis. He complaints of nightblindness, decreased ability to taste
food, and dry skin with hyperpigmentation. These complaints suggest deficiency
of:
F. Zinc *
G. Copper
H. Selenium
I. Chromium
J. Manganese
31.A 47 year old man presents to his physician with progressive abdominal
swelling.On examination he is found to have ascites and a tender,enlarged
liver.If the patient describes a chronic course associated with wasting and low
grade fever,the diffrential diagnosis should include everything EXCEPT:
F. Chronic Pancreatitis *
G. Tuberculosis
H. Cirrhosis with hepatocellular carcinoma
I. Hepatitis
J. Alcoholic liver disease with cirrhosis
32.A 45yr. Old man is admitted with his 3rd episode of upper gastrointestinal
haemorrhage. He had 2 prior ulcer operation. Zollinger-Ellison syndrome is
suspected. All the following would support your suspicions EXCEPT:
F. Supression of hypergastrinaemia by secretin given IV *
G. A fasting gastrin level of 450pg/ml.
H. Post operative notes detailling ulcers in the duodenum and jejunum
I. Liver metastasis on CT scan
J. A history of diarrhoea
33.A 60yr. Old woman, mother of 6 children, developed sudden onset of upper
abdominal pain radiating to the back, associated with nausea, vomitting, fever
and chills. Subsequently, she noticed yellow discoloration of her sclera and skin.
On physical examination the patient was found to be febrile with temp.of 38.9C,
along with right upper quadrant tenderness.Most likely Diagnosis:
F. Choledocholithiasis *
G. Benign biliary stricture
H. Malibnant biliary stricture
I. Carcinoma of the head of the pancreas
J. Choledochal cyst
34.The family doctor diagnosed in a patient an acute bleeding of an intestine. What
is professional tactics of the doctor in this situation?
F. The urgent hospitalisation in sergical departmewnt. *
G. To inject intravenously the aminocapronic acid.
H. The urgent hospitalization in therapeutic department.
I. A day time hospital.
J. A hospital at home.
35. A 39 year-old womam has jaundice. Blood examination shows total serum
bilirubin 127 mcmol/L, direct bilirubin 120 mcmol/L and alkaline phosphatase
2,8. The Diagnosis is:
A.
Viral hepatitis
B.
Chronic active hepatitis
C.
Haemolytic jaundice
D.
Hemolytic anemia
E.*
Obstructive jaundice
36. A 45 year-old male presents with jaundice. Total bilirubin is 93 mcmol/L,
direct is 81 mcmol/L, alkaline phosphatase 3,2. units. Diagnosis is:
A.
Viral hepatitis
B.
Chronic active hepatitis
C.
Hemolytic jaundice
D.
Hemolytic anemia
E.*
Obstructive jaundice
37. A 30-year man presented with fever, nausea and jaundice of 6 days duration.
The biochemical tests revealed a bilirubin of 35 mcmol/L (conjugated 15,9
mcmol/L), AST 0.99, ALT- 1.07. The serological tests showed presence of
HBs Ag, IgM anti-HBc and Hbe Ag. The most likely diagnosis is:
A.
Chronic hepatitis B infection with high infectivity.
B.
Chronic hepatitis infection with low infectivity.
C.
Acute hepatitis B infection with low infectivity
D.
None of above
E.*
Acute hepatitis B infection with high infectivity.
38. A 39-yr-old man presents with acute abdominal pain that radiates through to
the back. The pain is severe and causes him to feel sick and vomit repeatedly.
On physical examination you find the abdomen to be tender. His serum
amylase is five times greater than normal. Choose the single most likely
diagnosis
A.
Gastric atrophy
B.
Non-ulcer dyspepsia
C.
Basal pneumonia
D.
None of above
E.*
Acute pancreatitis
39. A 45-years man presents with acute abdominal pain in the epigastrium. The
pain radiates to the back between the scapulae. It is excruciating. The patient is
nauseous and vomits repeatedly. Choose the single most likely diagnosis
A.
Gallstones
B.
Gastric ulcer
C.
Duodenal ulcer
D.
None of above
E.*
Acute pancreatitis
40. A 50-yr-old secretary is brought to you with jaundice, malaise and tender
hepatomegaly. She has been drinking heavily for the past 2 weeks. Choose the
single most likely diagnosis from the list of options above.
A.
Hepatoma
B.
Malabsorption
C.
Pancreatitis
D.
Peptic ulcer
E.*
Cirrhosis
41. A 47-yr-old alcoholic presents with weight loss, fever, ascites and pain in the
right hypochondrium. Abdominal USG
A.
ws a focal lesion in a cirrhotic liver. Serum ?-FetoProtein is grossly elevated.
Choose the single most likely diagnosis from the list of options above.
B.
C.
D.
E.*
42.
Sclerosing cholangitis
Primary biliary cirrhosis
Wilson's disease
Pancreatic carcinoma
A 59 - year old man presents to his internist with jaundice. The patient is
receiving no medication and his only symptomatic complaints is mild fatigue
over the past 2 months. Physical examination is remarkable only for the
presence of scleral icterus. The patient has no significant past medical history.
Analysis of serum chemistry reveals the following: AST 0.58, ALT- 0.58.
Total bilirubin: 81.7 mcmol/L Direct Bilirubin: 46 mcmol/L Alkaline
phosphatase: 2,2. Which of the following is the next appropriate diagnostic
A.
step? biopsy
Liver
B.
Total blood count
C.
Coprogram
D.
Diastase of urine
E.*
Ultrasound
43. A 51-yr-old man complains of chronic ill health. He presents with malaise, low
grade fever and jaundice. His liver is large and tender and is jaundiced. Biopsy
of the liver demonstrates piecemeal necrosis. His HbsAg is positive and HbE
antigen is negative. Choose the single most likely management
A.
B.
C.
D.
E.*
Dexamethasone
Metronidazole
Laparotomy
Tinidazole
Interferon
44. A 43 year man complains of his appearance. His wife says his eyes are yellow.
On physical examination you find mild hepatomegaly. His alkaline
phosphatase, albumin and globulin are normal. He says he is a teetotaller.
choose the single most likely diagnosis from the list of options above
A.
B.
C.
D.
E.*
45.
Hepatocellular carcinoma
Cirrhosis
Gallstones
Pancreatitis
Chronic persistent hepatitis
A healthy young waiter complains of feeling unwell with nausea, vomiting and
diarrhoea. He has a headache, fever and abdominal pain. On palpation you find
the liver to be tender and enlarged. choose the single most likely diagnosis from
the list of options above
A.
Leukaemia
B.
Cirrhosis
C.
Gallstones
D.
Pancreatitis
E.*
Hepatitis A
46. A 48-yr-old stockbroker presents with jaundice and physical exhaustion. His
liver and spleen are enlarged and you notice he has spider naevi on both
cheeks. He says he is a moderate drinker and that he has been unwell for more
than a year now.
A.
Hepatitis B
B.
Hepatitis C
C.
Gallstones
D.
Pancreatitis
E.*
Chronic active hepatitis
47. A middle-aged social worker presents with abdominal pain and fever. She has
been unwell for 2 weeks and feels she is getting worse rather than better. Her
urine is dark and her stools are pale. She has tender lymph nodes and joint pain.
choose the single most likely diagnosis from the list of options above
A.
B.
C.
D.
E.*
48.
A.
B.
C.
Hepatitis A
Cirrhosis
Gallstones
Pancreatitis
Hepatitis B
A 41-year man presents with dull, aching pain in the right hypochondrium,
which he had for 3 weeks. Other complaints include impotence, arthritis,
lethargy and weight loss. Choose the single most likely diagnosis from the list
of options above.
Sclerosing cholangitis
Primary biliary cirrhosis
Wilson's disease
D.
Pancreatic carcinoma
E.*
Haemochromatosis
49. A 39-yr-old man with known ulcerative colitis presented with progressive
abdominal pain and itching. On examination he was jaundiced. Choose the
single most likely diagnosis from the list of options above.
A.
Haemochromatosis
B.
Primary biliary cirrhosis
C.
Wilson's disease
D.
Pancreatic carcinoma
E.*
Sclerosing cholangitis